Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 352657-4405 | UT |
NPI | 1194242925 |
---|---|
Provider Name | Jeanette Louise Seidel |
First Address | South Jordan, UT 84009-1513 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2017 |
Last Update Date | 23/08/2017 |